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Reports of Death of Medicare Advantage May Be Exaggerated

By John Reichard, CQ HealthBeat Editor

March 23, 2010 -- Last week, America's Health Insurance Plans said that cuts under the House Democratic health care overhaul package would "pull the plug" on the Medicare Advantage program. As it turns out, the Congressional Budget Office doesn't agree.

CBO estimates that by 2019 some 9.1 million people will be enrolled in Medicare Advantage, the private health plan side of Medicare. That's down from 11 million people now, but the 9 million would still a fairly big chunk of the Medicare population as a whole.

And while insurers warn that the cuts will erode benefits now received by Medicare Advantage enrollees, they'll still get more in benefits than enrollees in the traditional Medicare program.

But the program won't be nearly as big as it otherwise would be without the overhaul measure. CBO had projected enrollment would reach 13.9 million in 2019; the estimate means enrollment will be 4.8 million less than without the overhaul provisions.

CBO specifically analyzed the Senate-passed health care overhaul bill (HR 3590) as modified by the so-called reconciliation package (HR 4872) making changes needed to make the Senate measure acceptable to House Democrats. The House passed both proposals March 21, with President Obama signing HR 3590 into law Tuesday. Senate action is pending on the reconciliation package of modifications.

CBO projected that without the overhaul changes the value of extra Medicare Advantage benefits not covered by traditional Medicare would rise from $87 per month in 2009 to $135 per month in 2019. With the overhaul changes the 2019 figure would be $67 per month.

Medicare Advantage plans now deliver the $87 in extra benefits in the form of vision or dental care or lower premiums for Part B, the doctor care part of Medicare, or Part D, which covers prescription drug benefits.

CBO's analysis notes that under the overhaul revisions plans could no longer use Medicare subsidies for extra Medicare Advantage benefits to lower Part B or Part D premiums.

While declining enrollment wouldn't mean an end to Medicare Advantage, the disruption to seniors is traumatic. When dozens of private health plans pulled out of Medicare following cuts in 1997 balanced budget legislation, enrollees were forced to find other plans or return to traditional Medicare. A return to traditional Medicare would mean higher out of pocket costs for many seniors with modest incomes.

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